Ethical pain management in the emergency department: the canary in the coal mine.

The emergency department serves as the gateway to the acute healthcare system. In the USA and increasingly worldwide, patients view the emergency department as the venue where both diagnostic and therapeutic modalities will be brought to bear regardless of condition or socioeconomic status. At the same time, the emergency department is the canary in the coal mine--the warning location for difficulties in how healthcare is delivered to patients in both the outpatient and inpatient settings. In no area is this more apparent than pain management. Emergency departments are expected to treat patient's pain aggressively, often in the face of incomplete or contradictory histories and the inability to ensure outpatient follow-up. These factors create an ethical challenge for emergency departments in how to approach pain treatment. This paper will provide a framework for how emergency departments can address the ethical challenges posed by pain management.